Question

Nursing Diagnosis & Patient Goal- D.M. is a Caucasian female 75 years of age. She is widowed and lives alone in a two-story condo with her small dog. She describes her exercise routine as “walking her dog about a block three times a week,” but other than that, she does not regularly perform physical activity. She has a 30 year history of smoking 1/2 pack a day, however she quit once her doctor diagnosed her with COPD 15 years ago. Along with her personal history, D.M has a family history of diseases including breast cancer, heart disease, diabetes, and hypertension. About 6 months ago, D.M. began to notice an increase in fatigue along with increasing difficulty catching her breath when performing ADLs, such as getting dressed or walking around her home. She also ceased walking her dog and began to hire an outside dog walking service because she was unable to walk more than three houses down the block before she had to stop due to severe shortness of breath. Initially, D.M. was not concerned due to her COPD diagnosis and reports she thought “it’s part of the disease process,” but she began to worry when she started rapidly losing weight although she stopped her walking routine. She also began coughing up blood and running fevers twice a week. This prompted her to visit her primary care doctor who ordered chest x-rays. Chest x-rays revealed noticeable masses in D.M. 's lung, which prompted her primary care physician to refer to her cardiologist and subsequent recruitment of an oncologist to the team. An aspiration procedure was performed on one of the tumors and revealed the tumors to be malignant. D.M. The oncologist diagnosed her with extensive stage small cell carcinoma of both lungs and her first round of chemotherapy was scheduled, along with another set of CT scans to identify any metastatic sites. Today, DM presents for a check-up after undergoing her first chemotherapy treatment. She reports feeling fatigued and nauseous. She has not had a full meal in the past 24 hours due to “feeling like she will throw up if she even smells food.” DM is concerned that the rest of her treatments will make her feel worse than she already was and that her hair will start falling out if she continues treatment. She states, “I know it’s supposed to fight the cancer, but I feel so terrible.” Based on D.M. 's current presentation, the first step is taking vitals and performing a quick screen to rule down the possibility that D.M. 's reports are stemming from other sources than her recent chemotherapy treatment. If D.M. 's vitals and quick screen are normal, nursing can take the step of educating the patient on the expected symptom course of her treatment, as well as the benefits to keeping up with the treatments. This step can help ease the patient’s anxiety, as well as increase the likelihood of compliance with the treatment course.

Question: Explain what your nursing diagnosis is (What is the main problem for this patient? What need to be addressed?) Explain what your goal is for helping the patient recover (What do you want to change for the patient?)

Answer 1

The nursing assessment =

i. Monitor the Vita signs of D. M.

ii. Proper history of illness including the informations like as the family history, history of smoking, duration, no. Of cigarettes smoked in a day, history of alcohol and other substance abuse history.

iii. Head to toe physical examination had to done.

iv. Cardiopulmonary examination had to done.

v. Other laboratory reports had to check out.

Nursing Diagnosis =

I. Ineffective breathing pattern related to , bronchoconstriction secondary to COPD .

Goal = improve breathing pattern of the patient.

Interventions =

a) respiratory assessment has to be done.

b) patient has to be placed in a semifowler's position and provide comfort.

c) moist oxygen has to be administered through nesal cannula as per physician prescribed.

d) nebulization has to be administered with proper Bronchodialators.

ii. Nausea and vomiting related to improper digestion of food, low immunity, secondary to lungs carcinoma.

Goal = reduce nausea and vomiting.

Interventions =

a) peristaltic sounds has to be assessed.

b) balanced diet rich in protein and carbohydrates has to be administered.

c) small and frequent diet has to be administered by mouth.

d) antacids, antivomitics has to be administered as per physician prescribed.

iii. Imbalance nutrition related to improper digestion of food, imbalance nutrition lower than requirement.

Goal = improve nutritional balance of the client.

Interventions =

a) patient's body weight has to be measured.

b) proper balanced and small and frequent diet has to be administered.

c) physical activity has to be improved.

d) regular light physical exercise has to be perform.

iv. Anxiety related to present illness condition secondary to extensive small cell carcinoma in lungs.

Goal = reduce the anxiety of the patient.

Interventions =

a) support has to be given to the patient.

b) proper explanation has to given to the patient about his present illness condition.

c) help the patient to take right dicission.

v. Risk of infection related to low immunity, susceptibility to disease, secondary to lungs carcinoma and metastasis.

Goal =

Reduce the risk for infection.

Intervention =

a) proper sterile procedure has to be performed.

b) personal hygiene has to be maintained for the patient.

The channge has to be done for the client are =

A) lifestyle modification has to be done.

B) cessation of smoking has to be done.

C) proper balanced diet has to be take.

D) regular physical exercise has to be performed.

E) balanced diet has to be take in small amount and frequently.